Matsuda H, Miyamoto Y, Kaneko M, Otake S, Matsuwaka R
First Department of Surgery, Osaka University Medical School, Japan.
Nihon Geka Gakkai Zasshi. 1991 Sep;92(9):1267-71.
Extracorporeal membrane oxygenation (ECMO) is becoming an accepted therapeutic option for acute respiratory failure in both infants and adults. ECMO has been applied for relatively short-term support and numerous centers have reported satisfactory results with emphasis on patient selection, techniques of cannulation and perfusion, and prevention of complications. To use ECMO for a prolonged support, however, new type of artificial lung and system need to be developed. Most of the membrane oxygenators have the possibility of serum leakage through micropores. To prevent this problem, several dense membrane oxygenators have been developed and clinically used with good gas exchange. A low heparin dosage during ECMO results in reduced bleeding complication. Full systemic heparinization can be avoided during ECMO by using heparin-coated perfusion equipment. Respiratory support by means of pumpless PA-LA extracorporeal membrane oxygenation driven by pulmonary arterial pressure is attractive because of its simplicity and might be suitable for prolonged use. Further studies are necessary to develop an oxygenator for long-term ECMO.
体外膜肺氧合（ECMO）正成为治疗婴幼儿和成人急性呼吸衰竭的一种被认可的治疗选择。ECMO已用于相对短期的支持治疗，许多中心报告了令人满意的结果，重点在于患者选择、插管和灌注技术以及并发症的预防。然而，要将ECMO用于长期支持治疗，需要开发新型的人工肺和系统。大多数膜式氧合器都有可能通过微孔发生血清渗漏。为防止这一问题，已开发出几种致密膜式氧合器并在临床上使用，其气体交换良好。ECMO期间低剂量肝素可减少出血并发症。通过使用肝素涂层灌注设备，在ECMO期间可避免全身充分肝素化。由肺动脉压驱动的无泵肺动脉-左心房体外膜肺氧合进行呼吸支持因其简单性而具有吸引力，可能适合长期使用。开发用于长期ECMO的氧合器还需要进一步研究。
